Reduction Of Snoring Research Articles

Sleep Quality and Bariatric Surgery-Can We Treat Sleep Disturbances and Insomnia in Patients with Obesity with Laparoscopic Sleeve Gastrectomy?

Introduction: Bariatric surgery is the mainstay of treatment of obesity, with a proven, long-lasting effect on body weight reduction and remission of co-morbidities. Sleep disorders, including insomnia, and deteriorated sleep quality and duration are associated with obesity, and a reduction in body weight can be associated with a reduction in prevalence of sleep disorders. The purpose of this study was to assess the influence of laparoscopic sleeve gastrectomy (LSG) on the prevalence and intensity of different sleep disturbances. Methods: This observational prospective study included 80 patients qualified for bariatric surgery who filled in a questionnaire with a set of structured questions about different sleep disturbances, such as difficulties in falling asleep, night awakenings, early morning awakenings, snoring, and nightmares, as well as eating at night and daytime dysfunction, supplemented with Athens Insomnia Scale (AIS), before and 6 months after bariatric surgery. Results: There was a statistically significant reduction in incidence of night awakenings, with 40.00% of participants reporting night awakenings before surgery and, respectively, 25.00% after surgery. A significant reduction was also observed in the rate of patients who reported snoring, with 60.00% before the surgery and 38.75% after the surgery (p < 0.05). There was a correlation present between estimated weight loss % (EWL%) and reduction in snoring (p < 0.05). The mean total AIS score before surgery was 7.21 and 5.99 after surgery, and the change was statistically significant (p < 0.05). A total AIS score of 8 or more, the cutoff score for insomnia diagnosis according to the Polish validation of the Athens Insomnia Scale, was present in 44.16% of cases before surgery and in 38.00% after surgery (p = 0.52). There was a significant difference in the incidence of awakening during the night score before and after surgery (p < 0.05; CI 0.022-0.341), sleep quality (p < 0.05; CI 0.0105-0.4311), well-being during the day (p < 0.05; CI 0.0273-0.4143), and sleepiness during the day (p < 0.05; CI 0.101-0.444). Conclusions: LSG is observed to have a positive effect on selected sleep disturbances and insomnia remission in patients with obesity, measured by a significant reduction in Athens Insomnia Scale scores in follow-up 6 months after surgery. Additionally, patients after bariatric surgery reported less night awakenings and there was a lower rate of snoring. Therefore, LSG can be considered an effective therapeutic tool for insomnia in patients with obesity.

Patients’ perceptions of the importance of improvements and side effects from mandibular advancement device therapy for obstructive sleep apnea and snoring

ABSTRACT Objective To assess which improvements and side effects are considered most important by patients with OSA treated with a MAD. Methods A specific questionnaire consisting of 20 questions, including 10 questions on improvements and 10 on side effects, was developed and mailed to all subjects (54). Results 42 patients, participated in the survey by answering the questionnaire. The results showed that patients placed greater importance on the positive outcomes of treatment, with the most significant being the reduction in snoring and improvement in sleep quality. On the other hand, the side effects of difficulty speaking with the device, tooth mobility, and foreign body sensation were considered important. Conclusions The advantages perceived by the patients appear to outweigh the disadvantages, especially the reduction of snoring, increased productivity, and improved social and intellectual life. Most significant side effects are reversible and short-term, while occlusal changes, is not considered important by patients.

Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children.

The aim of this study was to analyze the relationship between breastfeeding duration and adenoid size, snoring and acute otitis media (AOM). We analyzed the medical history of children admitted to the ENT outpatient clinic in 2022 and 2023, reported symptoms, ear, nose and throat (ENT) examination, and flexible nasopharyngoscopy examination of 145 children aged 3-5 years. Breastfeeding duration of 3 and 6 months or more had a significant effect on the reduction of snoring (p = 0.021; p = 0.039). However, it had no effect on the adenoid size, mucus coverage and sleeping with an open mouth. Snoring was correlated with open mouth sleeping (p < 0.001), adenoid size with a 75% A/C ratio or more (p < 0.001), and adenoid mucus coverage in the Mucus of Adenoid Scale by Nasopharyngoscopy Assessment-MASNA scale (p = 0.009). Children who were breastfed for less than 3 months had more than a four-fold greater risk of snoring. There was a statistically significant correlation between AOM and gender (p = 0.033), breastfeeding duration in groups fed 1, 3 or 6 months or more (p = 0.018; p = 0.004; p = 0.004) and those fed with mother's breast milk 3 or 6 months or more (p = 0.009; p = 0.010). Moreover, a correlation was found between adenoid size and mucus coverage, tympanogram, and open-mouth sleeping (p < 0.001). Independent factors of snoring in 3- to 5-year-old children were breastfeeding duration of less than 3 months (p = 0.032), adenoid size with an A/C ratio of 75% or more (p = 0.023) and open mouth sleeping (p = 0.001). Children breastfed for 3 and 6 months or more exhibited reduced rates of snoring. There was no effect of breastfeeding duration on adenoid size in children aged 3 to 5 years, suggesting that the link between breastfeeding duration and snoring is primarily associated with craniofacial development and muscle tone stimulation. A breastfeeding duration of 1 month or more plays a key role in reducing the rate of AOM. The mother's milk plays a protective role against AOM. The presence of mucus might be responsible for snoring in preschool children. A medical history of breastfeeding should be taken into consideration when snoring children are suspected of adenoid hypertrophy.

Striking a balance between invasiveness and effectiveness of snoring treatment

Introduction: Snoring is a common form of breathing disturbances during sleep. Snoring is the most frequent an isolated symptom (called then primary snoring) but sometimes it is one of OSA or UARS symptoms. Primary snoring is not only a social but also a health problem. That is why we should diagnose and treat all the patients complaining of snoring. For many years, methods have been sought that would, on the one hand, ensure adequate effectiveness and, on the other hand, minimize the invasiveness of therapy.Aim: The aim of this study is to review the methods of snoring treatment paying attention to its invasiveness and effectiveness. Material and methods: The scientific publications on the Pubmed between 2005 and 2022 were reviewed using the key words.Results: A large variety of surgical procedures offered to patients who snore is an evidence to the lack of an optimal method of treatment. Methods of therapy are still being sought, which, on the one hand, would give a chance for a significant reduction of snoring and maintain this result for a longer period of time, and on the other hand, would be characterized by low invasiveness. One of the techniques that is characterized by low invasiveness and, at the same time, high efficiency in a selected group of patients snoring with the soft palate hypertrophy is the Er:YAG laser treatment.

Long-term outcomes of pharyngoplasty for Obstructive Sleep Apnea Syndrome.

Introduction: Pharyngoplasty techniques for the treatment of obstructive sleep apnea syndrome (OSAS) have evolved, which improved the understanding of the anatomy, patient selection, and adoption of functional approaches. Aim: To analyze long-term results of pharyngoplasty in OSAS patients. Material and methods: Between 2007 and 2021, a total of 234 adult patients with OSAS who had previously failed positive airway pressure (PAP) therapy underwent sleep surgery. Of this group, 75 patients met the criteria of a minimum 5-year follow-up. To date, 25 patients completed the follow-up study protocol, including the medical history, visual analog scale (VAS) for snoring loudness, body mass index (BMI), endoscopy of the upper airways, type III sleep study, and standardized questionnaires including Epworth Sleepiness Scale (ESS) and EQ-5D-5L Euro - Quality of Life Questionnaire. Results: The average period of follow-up was 96.80 ± 30.20 months. The mean age of participants was 54.6 ± 14.02 and the mean BMI 30.28 ± 2.74. Patients underwent uvulopalatopharyngoplasty (n = 21) and expansion sphincterpharyngoplasty (n = 4) between 2008-2015. A long-term improvement in sleep parameters was observed for the mean AHI (29.84 ± 20.06before and 19.45 ± 18.53 after surgery, p = 0.0294), and the median VAS (8.13 before and 3.78 after surgery), mean oxygen saturation during sleep 94,5% (IQR 93.0-95.25), and the median ESS score was 6.17 ± 4.57. The majority of patients reported subjective long-term improvement in sleep quality and a reduction of snoring. Conclusions: In OSAS patients who failed PAP therapy, pharyngoplasty may provide a long-term improvement in upper airway obstruction during sleep.

819 A RARE CASE OF RESPIRATORY SENSE LEAD DYSFUNCTION IN A PATIENT WITH A HYPOGLOSSAL NERVE STIMULATOR

Abstract Introduction In patients with moderate to severe obstructive sleep apnea (OSA) who are intolerant to PAP therapy, hypoglossal nerve stimulation (HGNS) is being increasingly considered as alternative treatment. Implantation involves placing cuff electrodes on inclusion branches of the hypoglossal nerve and a respiratory effort-sensing lead which is placed between the right intercostal muscle layers. These are connected to the implantable pulse generator which usually sits in a right infraclavicular pocket. Report of case(s) A 49-year-old male with severe OSA (AHI 30.8/hour) was implanted with a HGNS two years ago with successful activation a month later. He successfully up titrated his amplitude to the maximum stimulation level within his set range (0.9v – 1.7v). He underwent HGNS titration with AHI reduction to 13.9/hour at 2.1 volts and given a new higher range of 1.5 to 2.5 volts. This was accompanied by reduction in snoring, witnessed apneas and associated arousals with more consolidated sleep and improvement in his Epworth sleepiness score to 3 from 12 as noted prior to HGNS. The patient continued to up titrate over the next six months within his new range to 2.4 volts, when he reported increased sensitivity and intolerance at every stimulation level with recurrence of snoring and daytime sleepiness. He underwent interrogation of his device with subsequent awake endoscopy and change to his electrode configuration with a new lower range of 1.0 to 2.0 volts. However, he continued to have the same complaints. A second interrogation revealed increased impedance within the circuit of the respiratory sensing lead which was reproducible. The patient underwent sensing lead replacement in the operating room. He has since been able to increase stimulation levels without complaints and improvement in his OSA symptoms and is scheduled to have a follow-up hone sleep test (HST). Conclusion This case illustrates the importance of a structured approach in the evaluation of a reduced tolerance to HGNS. This includes assessing adherence, interrogation of the device’s circuitry, evaluating electrode configurations, stimulation thresholds with consideration for awake endoscopy. Repeating this process may be necessary to detect rare or delayed mechanical problems that may occur over time with HGNS. Support (if any):

A novel intraoral neuromuscular stimulation device for treating sleep-disordered breathing

PurposeTo ascertain the usefulness of a novel intraoral neuromuscular stimulation device in treating patients with primary snoring and mild obstructive sleep apnoea (OSA). This device uses daytime awake neuromuscular electrical stimulation (NMES) as an application to induce toning of the tongue muscles.MethodsA prospective cohort study of 70 patients with sleep-disordered breathing was conducted. Objective snoring and respiratory parameters were recorded with 2 consecutive night WatchPat sleep studies before and after treatment. The device was used for 20 min once daily for a 6-week period. Secondary outcome measures using visual analogue scale reporting of snoring by patient and Epworth Sleepiness Score (ESS) were recorded. Quality of life parameters were also noted.ResultsObjective reduction of snoring was noted on the sleep studies in 95% of participants, with an average snoring time reduction of 48%. Subjectively, the visual analogue scale reported by partners’ similarly demonstrated reduction in 95% of the patients with an average reduction of 40%. In a subset of 38 patients with mild OSA, AHI reduced from 9.8 to 4.7/h (52% reduction), ODI 7.8 to 4.3/h (45% reduction), and ESS from 9.0 to 5.1. Adverse effects encountered were minimal.ConclusionThis prospective cohort study demonstrates a notable improvement in both objective and subjective parameters of snoring and mild OSA in both simple snorers and patients with mild OSA. This device offers a safe and novel approach to reduce snoring and mild OSA by utilising intraoral neuromuscular electrical stimulation. This could be a preferred option for patients as it alleviates the need of using an oral device during sleep.Trial registrationclinicaltrials.gov identifier NCT03829956

0642 A Novel Daytime Intra-Oral Neuromuscular Stimulation Therapy in Simple Snorers: Objective Improvement in Snoring

Abstract Introduction The reduction in pharyngeal muscle tone in the upper airway is a pivotal factor in snoring and obstructive sleep apnoea (OSA).There is accumulative evidence that pharyngeal exercises can reduce snoring and OSA. We present a novel device SnooZeal® that uses daytime awake neuromuscular electrical stimulation (NEMS) as an application to induce toning of the tongue muscles. This study investigates objective changes in snoring and respiratory parameters with this device. Methods Prospective cohort study of 100 simple snorers was conducted. Objective snoring and respiratory parameters were recorded with 2 consecutive WatchPat sleep studies before and after treatment. SnooZeal® device was used for 20 minutes once a day for a 6 week period. Secondary outcome measures using visual analogue scale reporting of snoring by patient and Epworth Sleepiness Score (ESS) were recorded. Results Objective reduction of snoring was noted on the sleep studies in 95% with an average reduction of 48%. Subjectively, the visual analogue scale reported by partners similarly demonstrated reduction in 95% of the patients with an average reduction of 40%. Conclusion This prospective cohort study demonstrates a notable improvement in both objective and subjective parameters of snoring and respiratory indices. SnooZeal® offers a novel approach to reduce snoring by utilising intra-oral neuromuscular electrical stimulation. This could be a preferred option for patients as it alleviates the need of using an oral device during sleep. Support

Titanium Snoreplasty- A New Surgical Technique.

Introduction:Based on the previous data, among the general population aged between 30 and 60 years, snoring is observed in 44% and 28% of males and females, respectively. Therefore, it is important to treat snoring to reduce the disruption of the bed partner's sleep and the patients’ own problems. This study aimed to present a minimally invasive procedure which is easy to perform with less tissue damage. Materials and Methods:This study included 13 patients suffering from primary snoring with soft palate length of 2.5cm or more. All of the patients were examined and their partners were asked to fill-out the relevant questionnaires at baselines, 90 days, 6 months and 1 year after the surgery in order to assess snoring. A crescent strip of oral mucosa along with the underlying muscle were removed under general anesthesia followed by the insertion of a piece of oval-shaped titanium mesh. Moreover, two subjective methods were employed to assess the snoring of all patients.Results:11 patients were male, and the mean age and the mean body mass index of the patients were 48.69 years and 28.34 kg/m2, respectively. The scores obtained from the Visual Analog Scale for snoring loudness before surgery reduced from 7.63 to 3.54, which was statistically significant (P<0.05). None of the patients experienced major complications after surgery; however, there was a partial extrusion of the implant in one case which was managed conservatively with spontaneous healing.Conclusions:Titanium snoreplasty was successful in the reduction of snoring in this study. This method is a single-stage treatment for simple snoring with the multiple effects of palatal shortening, space increasing, and palatal stiffening.

An analysis on evaluation of surgical outcomes in zetaplasty for circumferential collapse of velopharynx: a case series

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Obstructive sleep apnoea syndrome is a disorder that involves periodic partial or total collapse of the pharyngeal airway during sleep which results in progressive asphyxia. It also leads to more insidious conditions including hypertension, diabetes mellitus, coronary artery disease, stroke, cognitive impairment and daytime somnolence. The aim is to analyse the surgical outcomes of series of 16 patients of OSA having circumferential collapse at velopharynx for which Zetaplasty was done by comparing pre-operative and post-operative symptoms, Epworth Sleepiness Scale, DISE and polysomnography.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study in 16 patients was done in our institute during the period from July 2017 to June 2018 and was followed for a period of 6 months. It comprised of 14 male and 2 female. At the patients in our study had complaints of snoring, frequent awakening at night and excessive day time sleepiness. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the 16 patients showed good improvement in symptoms after the surgery. There was around 50% drop in the post-op AHI. The post-op ESS score was also reduced. Lowest oxygen saturation improved significantly.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Zetaplasty for circumferential airway collapse at velopharynx level is a very safe and effective option as determined by the results of our study which is substantiated by reduction in AHI, ESS score and reduction in snoring. &lt;/p&gt;

A study on evaluation of pre and postoperative polysomnography for obstructive sleep apnea patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Obstructive sleep apnea is the most common form of sleep-disordered breathing. However, obstructive sleep apnea has been associated with much more insidious conditions, including hypertension, diabetes, heart disease, stroke, and daytime somnolence can lead to a dramatically increased risk of motor vehicle accidents.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was conducted in our institution in 34 OSA patients. After thorough evaluation with PSG, dynamic MRI, DISE patients were treated with various surgeries depending on the level of obstruction. Commonly UPPP, ESP, zetaplasty, tonsillectomy, tongue base reduction were done either alone or in combination. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Pre and postoperative polysomnograhpy for obstructive sleep apnea was evaluated and statistically analyzed. Significant proportion of patients improved both subjectively and objectively as determined by reduction in AHI from 41.73±13.94 to 15.77±9.13, reduction in ESS from 16.41+3.09 to 5.14±3.41 and reduction in snoring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; OSA can be easily treated with proper preoperative investigations, appropriate surgery, prevention of complications and continued lifestyle modifications. &lt;/p&gt;

Rapid Maxillary Expansion in Obstructive Sleep Apnea in Young Patients: Cardio-Respiratory Monitoring.

Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder which affects from 1 to 3 % of people during development. OSAS treatment may be pharmacological, surgical or based on application of intraoral devices to increase nasal respiratory spaces. The purpose of this study was to determine the efficacy of the Rapid Maxillary Expander in OSAS young patients by measuring cardio-respiratory monitoring parameters (AHI, the average value of complete and incomplete obstructed respiration per hour of sleep, and SAO2, the percentage of oxygen saturation). The study was conducted on 11 OSAS young subjects (mean age 6.9±1.04 years), all treated with rapid maxillary expansion (RME). Cardio-respiratory monitoring (8-channel Polymesam) was performed at the beginning (diagnostic, T0) and after 12 months of treatment. The mean values of cardio-respiratory parameters at TO were: AHI=6.09±3.47; SAO2=93.09%±1.60. After 12 months of treatment, the mean values of the same polysomnographic parameters were: AHI=2.36 ± 2.24;SAO2=96.81% ±1.60. These changes were associated with an improvement in clinical symptoms, such as reduction of snoring and sleep apnea. This study confirms the therapeutic efficacy of RME in OSAS young patients. This orthopedic-orthodontic treatment may represent a good option in young patients affected by this syndrome.

Impact of thyroidectomy on the control of obstructive sleep apnea syndrome in patients with large goiters

A large goiter can cause a series of compressive symptoms such as dyspnea and dysphagia, and previous case reports have indicated the coexistence of obstructive sleep apnea syndrome (OSAS) in these patients. The aim of this study was to evaluate the impact of thyroidectomy on the control of OSAS in patients with large goiters. Twenty-four patients with euthyroid goiters larger than 100 ml were consecutively selected. Of these, 17 (70.8%) presented OSAS and formed the research group. The protocol consisted of sleep questionnaires, physical examination, and polysomnography in baseline and after 3 months of surgery. The average age of the patients was 58.3±9.9 years, and there were 5 (29.4%) males and 12 (70.6%) females. The significant findings in the postoperative period included a reduced neck circumference (p=0.041), reduced Epworth sleepiness score (p=0.025), decreased percentage of high-risk OSAS cases according to the Berlin questionnaire (p<0.001), and a tendency for a significant reduction in snoring (p=0.052). However, polysomnographic respiratory parameters showed no significant improvement after surgery. Despite the high prevalence of OSAS in patients with large goiters and the improvement of OSAS symptoms, thyroidectomy showed no significant impact on the polysomnographic parameters.

Validation of the efficacy of an anti-snoring pillow

The aim of the study is to test the functionality of a prototype anti snoring pillow (position “forced supine”) on three-dimensional tissues “spacer” in order to assess the possible reduction of snoring and the possible reduction of respiratory events (apneas/ hypopneas). 15 patients have participated. Each had 2 full PSG studies evaluating the intensity and frequency of snoring by sound and visual recording of the patient’s sleep. Also examined were the quality and quantity of sleep (using EEG and EOG), respiratory activity via cannula, thermistor and thoracic and abdominal bands, the number of respiratory events (apneas, hypopneas), the level of oxygen desaturation and lower limb muscle activity (PLM) by EMG. We evaluated the subjective data of comfort and sleep quality of both the prototype and the usual pillow by patient questionnaire complted in the morning.. The results appear as numbers and percentages. No differences were observed in the macrostructure of sleep, or sleep efficiency between the patient’s usual pillows and the prototype. There are no differences in assessing different types of comfort pillow (7.5 vs 7.4). As for the polysomnography values: The prototype reduces the AHI by 743%, the number of snoring by 2470%, the index snoring for hour in a 4369%, time snoring in 1759 min compared with the usual pillow. The average intensity of snoring is reduced by 51% with the prototype. With the usual pillow comfort was evaluated as greater than the prototype (9 vs 3.2). These values show that these pillows could be a valid treatment for mild to moderate apnea.

Preliminary Findings from Our Experience in Anterior Palatoplasty for the Treatment of Obstructive Sleep Apnea

ObjectivesObstructive sleep apnea (OSA) is a common disorder affecting at least 2% to 4% of adult population characterized by the collapse of the pharyngeal airway. It is well established that retropalatal region is the most common site of obstruction. Consequently, many surgical techniques have been introduced. The purpose of this study is to present our preliminary results in the anterior palatoplasty (AP) compared with results of uvulopalatal flap (UPF).MethodsThirty-eight consecutive patients with mild-moderate OSA were prospectively enrolled into a randomised surgical protocol. Surgical success was measured primarily by satisfactory reduction in snoring, as reported by snoring assessment questionnaire (SQ) of sleep partners. Secondary outcomes measures included improvement in the Epworth Sleepiness Scale (ESS) scores, changes in the magnitude of pharyngeal collapse, and postoperative pain intensity.ResultsThe ESS after AP improved from a preoperative value 8.5±3.7 to a postoperative mean of 4.9±3.2 (P<0.001) after UPF improved from a preoperative value of 8.1±3.5 to 5.2±3.2 postoperatively (P<0.001). The results of satisfactory reduction in the volume of snoring and response at polysomnographic data were also similar in both procedures. We reported a statistically significant difference of the collapse noted at Müller manoeuvre that improved from 2.7±1.0 on average, to 1.1±0.9 (P<0.001) after AP and with a lesser extent, (from 2.8±1.1 on average to 1.8±1.1; P<0.05), after UPF. The mean duration of pain was 10.8 days for UPF patients and 7.1 days for AP patients. The mean pain score in the first 3 days, was 6.8 in UPF patients and 5.1 in AP patients.ConclusionThe subjective and objective improvements evidenced may suggest how AP is far superior to other techniques aimed at creating a palatal fibrotic scar. In the light of these results we can suggest AP procedure as more practical and comfortable when compared to UPF.

Effect of Upper Airway Stimulation on Snoring in Obstructive Sleep Apnea

Objective: Previous studies showed that electrical stimulation of the hypoglossal nerve can improve obstructive sleep apnea (OSA). This study aims to: 1) Learn whether upper airway stimulation has an effect on snoring in patients with moderate-to-severe OSA. 2) Learn whether there is a correlation between the reduction of snoring and obstructive respiratory events. Method: Upper airway stimulation systems were implanted in moderate-to-severe OSA patients (inclusion criteria: CPAP failure or intolerance, BMI &lt;32, without complete concentric collapse during drug-induced-sleep-endoscopy). Apnea-hypopnea-index (polysomnography) and snoring (5-level categories by bed-partner: no, soft, loud, very intense, intolerable by bed partner) were collected at pre-implant and 2, 4, and 6 months post-implant. Results: Nine subjects were implanted, and all have completed month 6 visit. All 9 subjects reported loud or very intense snoring at pre-implant. At the last visit, 4 subjects reduced from loud to no snoring, 4 subjects reduced from loud to soft snoring, and 1 subject reported no change. Reports from bed-partners were similar. The average AHI among the 9 subjects reduced from 39.4 ± 9.3 (mean ± SD) to 16.7 ± 21.7 ( P &lt; .05). Conclusion: Preliminary findings suggest that upper airway stimulation improves snoring along with the improvement of sleep disordered breathing in patients with moderate-to-severe OSA.

Harmonic Scalpel in the Treatment of Snoring

Objective: The Ultracision Harmonic Scalpel (HS) is an ultrasonic cutting and coagulating surgical device. The mechanism of the HS is based on transforming electrical energy into mechanical movement of 55.5 kHz frequency. This work aims to report our 4 years’ experience with HS in the treatment of snoring (uvulopalatopharyngoplasty). Method: Specific handpieces shaped like hook and blade were preferred. After tonsillectomy, 2 incisions, were made on each side of the lateral margin of the uvula, with upward direction. Thereafter, an excision of the redundant mucosa of each posterior arch and subsequent creation of neouvula by a partial uvulectomy was done. Results: In all the patients treated, the HS allowed rapid intraoperative management with a precise and safe cut: the HS provided excellent control without side effects on the adjacent structures and postoperative complications. Compared with other techniques (laser, cold knife dissection, etc) HS’s group experienced shorter operation time, lesser blood loss, fewer days of hospitalization, lower postoperative pain, and improvement of voice quality. No complications with regard to hemostasis or other major complication (temporary velopharyngeal insufficiency, bleeding, globus sensation, etc) were noted in the HS group. Conclusion: Our experience highlights that the use of HS in uvulopalatopharyngoplasty confers some advantages over conventional methods: its use led to diminished bleeding, shorter operation time, lesser pain, better wound healing in the postoperative period, and reduction of snoring and improvement of voice quality.

Manejo del SAHS mediante dispositivos de avance mandibular. Estudio preliminar

The most effective treatment in patients with sleep apnea-hypopnea syndrome (SAHS) is CPAP (continuous positive airway pressure). The main drawback of CPAP is the discomfort and claustrophobic sensation that it causes, which elicits rejection or intolerance by some patients. A non-surgical alternative to CPAP is the mandibular advancement device (MAD), which consists of a plastic splint inserted between the dental arches to shift the jaw and tongue forward and thus increase airway volume. Objective Report our experience with the treatment of SAHS using the Herbst mandibular advancement device. Material and method A prospective follow-up study was carried out from June 2006 until January 2009 at the Virgen Macarena University Hospital with 7 patients with SAHS who refused treatment with CPAP and were treated with the mandibular advancement device. The outcome variables analyzed were: apnea-hypopnea disruptions per hour index, desaturations per hour index, subjective intensity of snoring, and the Epworth Sleepiness Scale. Variables were evaluated pre-treatment and at least once 6 months after initiation MAD use. The Wilcoxon test for paired samples was used to detect statistically significant differences (p<0.05). Results A statistically significant reduction in the hourly indices of apnea-hypopnea disruptions (p<0.018) and desaturations (p<0.018) was observed, as well as a statistically nonsignificant reduction in snoring and sleepiness. Conclusions Use of the Herbst mandibular advancement device in patients with obstructive sleep apnea syndrome who refuse CPAP may be helpful as it improves the clinical and functional parameters of the condition.

Effectiveness of Pillar Implants in Snoring Management

Objective Determine the effectiveness and complications of Pillar implants for snoring management in the course of routine clinical practice. Methods Retrospective series of adult patients receiving Pillar implants for snoring management between January 2005 and December 2007. Outcomes include procedure-related complications and patient satisfaction with snoring control. Results A total of 58 males and 12 females with an average age of 56 years (range, 33 to 74 years) underwent placement of Pillar implants for socially disruptive snoring. 21 patients were snorers, whereas 49 had mild to moderate degrees of sleep apnea. 41 patients were treated with 3 implants, and 24 patients received 4 or more implants. The procedure was performed in the outpatient setting in 47 cases and in the operating room in 23 cases. Complications included poor placement requiring removal (5 patients), and implant extrusion (4 patients). Complications were more common with implants placed in the OR, compared to the outpatient office (p=0.004). Of the patients with sufficient 3-month follow-up, 35/54 (65%) reported reduction in snoring, however only 28/54 (52%) were completely satisfied with the level of snoring reduction. When the satisfied patients were compared to dissatisfied patients, there were no noted differences in mean age, diagnosis of OSA, the use of adjunctive nasal surgery, or the number of implants placed. Conclusions Pillar implants offer satisfactory snoring reduction in approximately 50% of patients. Additional study is needed to determine factors that increase the probability of success. Implants placed under general anesthesia have a higher risk of poor placement and extrusion.

Reduction of Snoring with a Plasma-Mediated Radiofrequency-based Ablation (Coblation) Device

We evaluated the effectiveness of using a plasma-mediated radiofrequency-based ablation (Coblation) device to perform volumetric tissue reduction of the soft palate as a means of controlling snoring in 23 patients with loud snoring and mild or no sleep apnea. Tissue reduction was achieved by performing a channeling procedure designed to shrink the tissue surrounding the treatment zone. The soft palate was treated at three separate sites, and each channel was completed in approximately 11 seconds. Data regarding the primary outcome--that is, pre- and postoperative subjective assessments of snoring intensity provided by the patients' bed partners--were available for comparison for 21 of the 23 patients. Of the 21 patients, treatment was deemed successful in 10 (48%). Postoperatively, the overall mean intensity of snoring on a scale of 0 (no snoring) to 10 (terrible snoring) fell by 4 points (p < 0.05). Likewise, the loudness of snoring was also significantly reduced on objective SNAP recordings; the mean intensity fell from 12 to 8 dB (p < 0.05). Of the 10 successfully treated patients, 2 required only one procedure, 5 were improved after two treatments, and 3 underwent three operations. Seventeen of the 23 patients (74%) reported an improvement in quality of life. Surgical complications were mild to moderate, and pain was easily manageable in most cases. Our findings suggest that this procedure can be an effective treatment for socially unacceptable snoring. We hope that in future studies, investigators will evaluate outcomes over a longer term.